Healthcare Provider Details

I. General information

NPI: 1770346751
Provider Name (Legal Business Name): EYE CARE ASSOCIATES OF CO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2024
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 N SUMNER AVE
CRESTON IA
50801-1350
US

IV. Provider business mailing address

PO BOX 879
FORT WASHINGTON PA
19034-0879
US

V. Phone/Fax

Practice location:
  • Phone: 641-782-2111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DAVID DEPPEN
Title or Position: SENIOR DIRECTOR, REVENUE CYCLE
Credential:
Phone: 937-539-8057